080900093w,['
�UZtt
_=rn
_qw:q
a��yP(7
h
03
Eno
=u
CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CONTRACTORINFORMA'IO1V"':
. RR�u,�x•IDa,; ..�=�,. ... `�.., rd:1%�.b?t^°a �SYtW$`Fi 'R�
BDILMVbD9FshLEM AVE
AKEENA SOLAR, INC
P�08090009
.;R'S NAME:
PERMIT ISSUE DATE
TONY GAO
16005 LOS GATOS BLVD
09/19/2008
PHONE
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
INSTL 24 RF MNTED SOLAR
BUILDING
'BLDG ELECT PLUMB
PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
lob Description
I hmcbY affirm that 1 am licenced under ns ors 9 (commencing.
P
and prof CodO,
3OfNe Bwcressend Profcasiou Cade.mtl my lieetw is
with Sectim ]p1ef
effect.
in full force end effect 05%73 .
U G �/ 6 Lk. e
ame CCIsa.
Data, /"6
—V4"62 TCamDnEcCL ARATION
AICHIIE
1utlnunJmypinsAgIbeNupuM1licrtcom
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby Affirm that I em exempt from the Conu gm's IJcae Law for the
following .Aeon. (Sauon TI 31.5. Business; And Professions Cade: Any city or county
which requires • Permit In cmAumt ale. improve, kno,l W, or ¢pair Any structure
prior to its issuance. also requires Nc applicant forsuch pewit to pk a signed statement
that he is licensed pursuant m the provisions of Ne Contractors License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section ]000) of Division 1 of the Business And Profession, Code) or
that W On exempt Nertrrom And the ban;fm Ne alleged exemption. My violation of
Seedm]011.5 by Any, applicant for aponothsubjata Ne applicant in a evil penalty or
APN Number
Occupancy Type
P Y
nal. thus live hundred dollars ($M
YP
❑ l,uawrcs of the pmpmy,amy uvployas with wgmude'vsokcampctmum,
will Pn l e wart end a he Cmrt ta sl NLaded m AW din (rasa apply of An MM Of
And Pmresdons ease The conmNnn Liege Law aces rot apply a ars ower
Required Inspections
i thertoa And who is
essmh ark himaehror through hu
enywyees.
ove d thavu
provi Norah improvements ar
nu art not ear dedofo mOBcrtd the
own wplthe
of I Owner..
bowever. u(mpmvemmtkhat within one year orimproetion.for the Owren
Wildingsold
Wilder will have esu burden of proving that M did rot Wild m improve for purpose or
uloJ.
❑ 1, as Owner of Ne prnpe ry, am exclusively contracting with licensed contractors in
COmINeI the nnject (So.. ]pad, Bushey And Professions Code:) The Cmracbn U.
LLMC Law daJ not apply us an owner of property who Wilds of improves thereon, and,
who concocts for such projects with a conoecuu(s) licensed pursuant m the Connaeton
JW.
Ilomu
omuemptundm See ,BAPCfmthisrtamn
ner Dat
WORKER'S COMPENSATION DECLARATION
1 hereby afTum under penalty o(pejor, one of the following decluauonc
❑IN.eeM will mainuioACenirimth of Camera to salt -insure ra Wortefs Compen-
'
ration, As provided for by Secure 7700 of the Labor Code, for the performance or the
art for which this pumtl is issued.
❑ 1 have And will maintain Waters Compensation Insurance, as required by Secure
3100of the Mbar Code, for the performance often wort for which this permit is Wood.
'
My Worker ensation hada nee center Compand Policy number am:
Carrier. �G-1 Policy No.: 3Y 2 8ZSS
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
md, son im need not In cwplcwd if the pewit's foronc hundred dORus (SIM)
lir lou)
1 certify Net in the perfowmee of the wait for which this pewit is issuM. I shJl nee
'
employ any person homy manmrm As t Imeo ne subject to Use Worker,' Compemadon
Laws or California. Dat
Applicant
NOTICE TO APPLICANT: If, ager making this Ccnioese of Exemption. you Wu5
become Subject to the Wohm's Compensation provisions m the Lsbm coda you met
foMwith comply with such pmvidnns Or Nu pewit shall be dremed n voted.
CONSTRUCTION LENDING AGENCY
1 hertby aRiw that thce u s connructinn lending apney for the RIf.. of
die ark for which this Pewit is issued (see 7097, Ci, Q
Lendsrs Name
-
Lenders Address
I uaufy than l have toe WA appftcatim ArW some Nu the chow kfo mmon IA
covet I since a mmPly withal city end comfy omlneooat AM cut Ins mlad.$ to
Wilding construction, and tueby Authoria representatives of this city to ewer upon the
.
mope for inspection which
(We) agree m Ann, indemnify Nd keep hWmkaA to City of L'apenum sga(ml
HAMM=,ju gm rt may
mtl exyemee which may in anY wayurns againstsaid City
in COnuesuensoC Or
in eonAcgrcme of Ne granting Of this pewit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
REGULATIONS.
Issued by: Date 4f_- /y^
r?9,(SOURCE
q�l9�OfJ
Re -roofs
Stgnuum of Applicepat
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
WIII No applicant u rmum building occupant sort or handle ety
/
defined by the Cupertino Municipal Cade. Chapter 9. J2. and the Ha1N anJ Safely
Hooldomd Safety
_aJe, Secp 35511(x)] ON.
All roofs shall be inspected prior to any roofing material being installed.
Will the Applicants or future building occupant use equipment Or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
emithauumm air cmumi... In u dermd by Ne Bay Area Air Quality Management
all new materials for inspection.
❑Yo YNo
Ilovemeithedr Sw6s
enuunder Chaptr G97ofticbuii
25505, 5533rt
ondnuaMNUBNu S
Out ComealHyCoda SrcJusouitI
dos re,ma,sum51a.1
rts Ne acupAnt of Je
,offs
Jens rotes
x INeitumy
which must Or.Cemmmaty
requirements which mutt a met prior m iuusroc of a Cvdfeat of Occupuey.
Al— 4 971
Signature of Applicant Date
All roof coverings to be Class'Aw or better
Owner or auNonmd agent p,t